Provider Demographics
NPI:1366801169
Name:PLAY ABA, LLC
Entity type:Organization
Organization Name:PLAY ABA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FACHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MAT, BCBA
Authorized Official - Phone:408-663-6652
Mailing Address - Street 1:19132 COZETTE LN
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3538
Mailing Address - Country:US
Mailing Address - Phone:408-663-6652
Mailing Address - Fax:
Practice Address - Street 1:19132 COZETTE LN
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3538
Practice Address - Country:US
Practice Address - Phone:408-663-6652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health